571: Lactic acid measurement to identify risk of morbidity in pregnancy

ObjectiveLactic acid (LA) is a well-known marker for sepsis. The utility of LA measurement for sepsis in pregnancy is unknown and is the objective of this study.Study DesignRetrospective cohort of pregnant and postpartum patients with clinical suspicion of sepsis in the ED. Data abstracted included temperature, heart rate, blood pressure, respiratory rate, oxygen saturation, white blood cell count, percentage of immature neutrophils, and LA. Outcomes included intensive care unit (ICU) admission, telemetry unit admission, positive blood cultures, positive influenza swabs, and perinatal outcome. A linear regression model was used to evaluate the association between LA and adverse outcome. Outcomes were also compared by mean LA level.ResultsOf 850 eligible women included, 159 had LA drawn. LA level was positively associated with requiring a higher level of care (admission to an ICU or telemetry unit), adjusted odds ratio (AOR) 2.34, 95% confidence interval (CI), 1.33-4.12, and positive blood cultures (AOR 1.6, 95% CI 0.83-3.08). In patients admitted to the ICU, the mean LA level was 2.6, versus 1.6 in those not admitted to the ICU, p=0.04. A similar trend was seen in those requiring telemetry unit admission (2.0 versus 1.6, p=0.03) and with positive blood cultures (2.2 versus 1.6, p=0.003). Patients who had LA drawn differed from those who did not. Overall, they had higher morbidity rates: more likely to have positive blood cultures (16.8 versus 5.5%, p=0.039), require ICU (5 versus 0.1%, p<0.0001) or telemetry unit (17.2 versus 0.9%) admission, have a longer hospital stay (3.5 versus 2.7 days, p=0.0002), and deliver preterm (18.3 versus 10.9%, p=0.049). There was no association, nor was there a difference in the LA level, among patients with positive influenza swabs or in perinatal outcome.ConclusionElevated LA in pregnancy is associated with adverse outcomes from sepsis, including increased risk of ICU and telemetry unit admission and positive blood cultures. In this cohort, having LA drawn was a marker of more severe infection. ObjectiveLactic acid (LA) is a well-known marker for sepsis. The utility of LA measurement for sepsis in pregnancy is unknown and is the objective of this study. Lactic acid (LA) is a well-known marker for sepsis. The utility of LA measurement for sepsis in pregnancy is unknown and is the objective of this study. Study DesignRetrospective cohort of pregnant and postpartum patients with clinical suspicion of sepsis in the ED. Data abstracted included temperature, heart rate, blood pressure, respiratory rate, oxygen saturation, white blood cell count, percentage of immature neutrophils, and LA. Outcomes included intensive care unit (ICU) admission, telemetry unit admission, positive blood cultures, positive influenza swabs, and perinatal outcome. A linear regression model was used to evaluate the association between LA and adverse outcome. Outcomes were also compared by mean LA level. Retrospective cohort of pregnant and postpartum patients with clinical suspicion of sepsis in the ED. Data abstracted included temperature, heart rate, blood pressure, respiratory rate, oxygen saturation, white blood cell count, percentage of immature neutrophils, and LA. Outcomes included intensive care unit (ICU) admission, telemetry unit admission, positive blood cultures, positive influenza swabs, and perinatal outcome. A linear regression model was used to evaluate the association between LA and adverse outcome. Outcomes were also compared by mean LA level. ResultsOf 850 eligible women included, 159 had LA drawn. LA level was positively associated with requiring a higher level of care (admission to an ICU or telemetry unit), adjusted odds ratio (AOR) 2.34, 95% confidence interval (CI), 1.33-4.12, and positive blood cultures (AOR 1.6, 95% CI 0.83-3.08). In patients admitted to the ICU, the mean LA level was 2.6, versus 1.6 in those not admitted to the ICU, p=0.04. A similar trend was seen in those requiring telemetry unit admission (2.0 versus 1.6, p=0.03) and with positive blood cultures (2.2 versus 1.6, p=0.003). Patients who had LA drawn differed from those who did not. Overall, they had higher morbidity rates: more likely to have positive blood cultures (16.8 versus 5.5%, p=0.039), require ICU (5 versus 0.1%, p<0.0001) or telemetry unit (17.2 versus 0.9%) admission, have a longer hospital stay (3.5 versus 2.7 days, p=0.0002), and deliver preterm (18.3 versus 10.9%, p=0.049). There was no association, nor was there a difference in the LA level, among patients with positive influenza swabs or in perinatal outcome. Of 850 eligible women included, 159 had LA drawn. LA level was positively associated with requiring a higher level of care (admission to an ICU or telemetry unit), adjusted odds ratio (AOR) 2.34, 95% confidence interval (CI), 1.33-4.12, and positive blood cultures (AOR 1.6, 95% CI 0.83-3.08). In patients admitted to the ICU, the mean LA level was 2.6, versus 1.6 in those not admitted to the ICU, p=0.04. A similar trend was seen in those requiring telemetry unit admission (2.0 versus 1.6, p=0.03) and with positive blood cultures (2.2 versus 1.6, p=0.003). Patients who had LA drawn differed from those who did not. Overall, they had higher morbidity rates: more likely to have positive blood cultures (16.8 versus 5.5%, p=0.039), require ICU (5 versus 0.1%, p<0.0001) or telemetry unit (17.2 versus 0.9%) admission, have a longer hospital stay (3.5 versus 2.7 days, p=0.0002), and deliver preterm (18.3 versus 10.9%, p=0.049). There was no association, nor was there a difference in the LA level, among patients with positive influenza swabs or in perinatal outcome. ConclusionElevated LA in pregnancy is associated with adverse outcomes from sepsis, including increased risk of ICU and telemetry unit admission and positive blood cultures. In this cohort, having LA drawn was a marker of more severe infection. Elevated LA in pregnancy is associated with adverse outcomes from sepsis, including increased risk of ICU and telemetry unit admission and positive blood cultures. In this cohort, having LA drawn was a marker of more severe infection.